Admiral William J. Fallon: Global Health Matters to the U.S.

One of the greatest misconceptions about global health is that it only matters to developing nations. Global health deeply affects the economy and security of the United States, and that was the central message of Admiral Fallon's keynote address for a gathering of global health experts and North Carolina businesspeople and policymakers.

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Keynote Speech for 'Why Global Health Matters to North Carolina'

William J. Fallon

9/21/09

THANK YOU, WELCOME

Thank you David, for your kind introduction and for moderating this event. Before getting started I want to give a few quick words of thanks: First to my fellow Commissioners, and good friends, Peter Lamptey and Mike Merson, both of whom you will be hearing from later this afternoon. A thank you is also owed to Geelea Seaford from Duke and Karen Meacham from CSIS, for playing pivotal roles in bringing us all together today. Finally, I want to make special mention of Rick Copeland (will be in audience) who has been particularly helpful to the Commission. And, of course, thank you to everyone who has joined us this afternoon. This promises to be an exciting event.

I'm going to keep my remarks brief and focused in three areas:

First, you might be wondering why I am chairing an effort on global health and what this CSIS Commission is all about. So let give you some background.

Next - and this will be the focus of my remarks - I want to relate the Commission's work directly to North Carolina and explain why the Commission is so interested in this state

I'll wrap up my remarks by discussing where the Commission is going with its work and how all of you in this audience can help us.

ABOUT ME AND HOW I CAME TO THE COMMISSION

I am co-chair of the CSIS Commission on Smart Global Health Policy. The Commission is a collection of 25 leaders, from diverse backgrounds, who have come together to create and offer a collective view on a long term, strategic approach to U.S. engagement in global health. We will put out a final report with recommendations at the end of the year.

Better promoting global health is not going to be quick nor will it be easy. Many of these challenges have been with us for a long time, and they will not go away over night. We need to clearly identify gaps in health, find cost-effective ways of closing those gaps, and develop an action plan with accompanying metrics, to get there. This kind of long-term commitment to global health recognizes the premise that investments in health, while benefitting people first, are also of direct importance to U.S. national interests.

The Commission is trying to do business differently than what has been done in the past. Unlike many other Washington efforts, we're trying to reach outside the beltway to solicit ideas from global health experts and interested citizens across the U.S. We're in North Carolina today to talk a little bit about the Commission, but also to hear from you. We're reaching out across the U.S. in other ways, as well, primarily through our interactive website smartglobalhealth.org.

The Commission's membership is also different. One-third of our commissioners are known global health experts like my co-chair, Dr. Helene Gayle, CEO of CARE; and our colleagues here today - Peter of Family Health International and Mike of Duke's Global Health Institute. The rest of the Commissioners are opinion leaders and accomplished strategic thinkers from outside of health. We have members of Congress - Republicans and Democrats; business, foreign policy and media leaders; university and philanthropic leaders; and - like myself - members of the security community. I was enlisted into this effort because of my security background, and the perspective that brings to the Commission's work.

I spent more than 40 years of my life serving in the U.S. Navy, serving around the world, as well as Commander of both U.S. Pacific Command and U.S. Central Command. When I was a student at the U.S. Naval War College, security was defined in very traditional terms. It was the business of competing sovereign state actors with defined borders who pursue hard national interests.

Working on the ground in the far corners of the world, however, I came to appreciate that security today is much more about basic day-to-day existence - it's primarily about the security of the individual. Included in this, the way people relate to each other, their families, their jobs and their communities. It is broader and far more personal than traditional notions of security. And at the heart of human security is health.

First, human security is a basic pre-requisite for health. There need to be conditions of basic stability and predictability - freedom from fear, abuse and displacement - for health interventions to be effective and have a real impact.

Second, many of the major threats against an individual's well being are no longer contained by national borders. They are trans-sovereign in nature. Nothing so clearly captures this phenomenon more than the issue of emerging infectious diseases. And this is no surprise to any of you sitting here, particularly as we enter flu season. SARS, avian influenza - and most recently H1N1 flu - have raised our consciousness that pathogens can cross borders and threaten the security of people and their societies.

RELATING THE COMMISSION TO NORTH CAROLINA

But now the big question of the day: what is the co-chair of this Commission doing in North Carolina?

A few weeks ago I traveled to Kenya and Ethiopia as part of a Commission field trip. We went there in order to see, in real time and in concrete detail, the major successes and challenges of doing health work in a developing country.

Now this might surprise you but I saw North Carolina in Kenya.

While in Nairobi, we traveled to Kibera - the largest slum in East Africa, one of the most densely populated urban settlements in the world. And there, in Kibera, we visited a medical clinic run by an NGO called Carolina for Kibera.

Carolina for Kibera is a partnership between Duke and UNC. So there in Kenya two North Carolina universities, known across the country as fierce competitors, coming together to make a difference in the health of thousands of people. It's a remarkable thing. And this unlikely partnership has been so successful, that the Centers for Disease Control and Prevention latched on as a third partner, building upon the hard work and dedication of North Carolina students to create CDC surveillance and training programs in the area, and bring in full-time medical doctors to serve Kibera residents.

So what did we learn from Carolina for Kibera?

The first observation is the importance of partnerships in resource limited settings. Carolina for Kibera's partnership with the CDC is innovative and should be celebrated.

The second observation is about the importance of community buy-in and support of health programs, in order for them to succeed. Kibera is a tough area - it is ethnically divided and has a history of violence. But during the 2008 post-election crisis in Kenya, Kibera residents protected the Tabitha medical clinic from damage. It is clear that unless health programs are supported by locals, they will remain vulnerable.

The third observation is about the difficulty of promoting health in dense urban settings. The world is changing and becoming increasingly urban - we need to learn how to better detect, diagnose, and respond to health threats in these settings. Carolina for Kibera - with its CDC partnership - is on the forefront of that work.

The Commission also traveled out to the Kenyan coast and, again, we found North Carolina. In Mombasa, Family Health International, another NGO, is leading an integrated health effort that crosses multiple diseases and provides support and empowerment programs for vulnerable populations. Peter was with me on this visit, and has been crucial to the program's success, so I'll invite him to say more about the good work they're doing in Mombasa shortly.

I mention it, though, because it is another example of an organization based here in North Carolina that is not only providing essential services to Kenyans, but doing so in an innovative and sustainable fashion. And these programs are fundamentally about disease prevention and human security.

So let me just quickly return to the work of the Commission and tell you how we propose to integrate these lessons from Kenya and North Carolina into our work.

On October 16 the Commission will meet for its second and final time to further discuss what a long-term, strategic approach for the U.S. should look like.

We know thus far that a strategic approach to global health must rest on four pillars:

First, it must be grounded in sound public health. Reducing mortality and morbidity rates must be a guiding principle, and we need to do this in a cost-effective manner that focuses on prevention. This means continuing our hard work on infectious disease threats, but also looking over the horizon to emerging conditions, particularly non-communicable diseases.

Second, we know an effective strategy must engage women and recognize them as drivers of social change. We need to put a heavier, long-term investment in improving maternal and child health, to create stronger and more secure families and communities. I'll let Peter speak more to this issue.

Third, as Peter will discuss in some detail, we need to better integrate health investments with broader development goals. A big question is: How can we better link health programs with programs on agricultural productivity, nutrition, markets, roads, water and sanitation, and education?

And fourth, as discussed at the beginning of my remarks, we need to ensure that the protection of human security rests at the center of our efforts. Prioritizing human security means investing significantly, over the long term, in the global surveillance and response capacities of developing countries. It also demands that we create new multilateral mechanisms that expand timely, affordable access to key medical commodities in times of health emergencies. If we faced a global health emergency today, how would we grapple with these difficult ethical questions?

The Commission is working hard to further elaborate these ideas, and craft recommendations for the White House and Congress. This report is still very much a work-in-progress, and we are looking for fresh insights - particularly from you.

As we saw in Kenya, the work that is being done in North Carolina is terribly important for global health, and it's terribly important for the United States. This is worth celebrating in its own right. But it's also very valuable to those of us in Washington and we want your voice - and those of other centers of excellence - to come across in the Commission's report.

We need you to join our effort. Go to our website, www.smartglobalhealth.org, and convey your views to us. We need your assistance in making the Commission's report as strong as it can be, and in pushing a strategic approach to global health forward. I have confidence that with your help, we can succeed. Thank you.

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